title: "Cherry picking", a multiple non-anatomic liver resection technique, as a promising option for diffuse liver metastases in patients with neuroendocrine tumours.
abstract: BACKGROUND
  Liver metastases of GEP-NETs are a known major prognostic factor with a strong effect on patients' survival. To date, various treatment options are available, whereas surgery remains the only curative option. Because large liver resections often cannot be performed due to insufficient remnant liver volume, a special operative technique, "cherry picking" (multiple nonanatomic liver resections), can be used as a tissue-preserving procedure.
  
  
  METHODS
  Of 91 patients with various GEP-NETs, 16 patients were identified with synchronous or metachronous multifocal, bilobular liver metastases (>10). All were treated with "cherry picking." Patient records were reviewed retrospectively and clinical data and pathology results were analyzed.
  
  
  RESULTS
  Mean survival after primary tumour resection was 82.8 versus 41.2 months after liver surgery. All 16 patients are still alive. Mean recurrence-free survival after primary tumour operation was 49.8 versus 24.6 months after liver surgery. Complications of cherry picking included two postoperative biliary leakages and three small hepatic abscesses (conservative/interventional approach 25 % (n = 4), surgical approach 6.25 % (n = 1). There was no postoperative mortality. Initial hormonal symptoms (5/16 patients) completely disappeared postoperatively in 2 patients and were significantly decreased in 3 patients.
  
  
  CONCLUSIONS
  The tissue-preserving surgical technique "cherry picking" has developed due to improved imaging techniques and increased knowledge in liver anatomy, which has helped to make this approach safer and easier. Highly selected patients with multiple bilobular liver metastases of GEP-NET can benefit from this special surgical approach, also applicable for recurrent metastases.
authors.affiliation: Department of General, Visceral and Pediatric Surgery, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany, krausch@med.uni-duesseldorf.de.
authors.forename: Markus
authors.initials: M
authors.lastname: Krausch
authors.forename: Andreas
authors.initials: A
authors.lastname: Raffel
authors.forename: Martin
authors.initials: M
authors.lastname: Anlauf
authors.forename: Matthias
authors.initials: M
authors.lastname: Schott
authors.forename: Nadja
authors.initials: N
authors.lastname: Lehwald
authors.forename: Andreas
authors.initials: A
authors.lastname: Krieg
authors.forename: Stefan Andreas
authors.initials: SA
authors.lastname: Topp
authors.forename: Kenko
authors.initials: K
authors.lastname: Cupisti
authors.forename: Wolfram Trudo
authors.initials: WT
authors.lastname: Knoefel
mesh_terms: D000328:Adult; D000368:Aged; D005770:Gastrointestinal Neoplasms / Q000473:pathology*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed